Viewpoint - Beware NHS Commissioning Board power

Paul Corrigan: the NCB will decide if CCGs can be authorised (Photograph: JH Lancy)

Those GPs who want their practices to join clinical commissioning groups (CCGs) need to pay close attention to the evolution of the NHS Commissioning Board (NCB).

In July, NCB chief executive designate Sir David Nicholson issued a consultation document, Developing the NHS Commissioning Board, about how the NCB might develop within the new NHS architecture.

Not surprisingly this architecture puts the NCB at the centre of the NHS and suggests that it should be called NHS England.

If, in your local area, GPs are not ready for commissioning local care by April 2013, the local PCT will not do it. Instead, local commissioning will be nationalised under the NCB.

It is necessary for new organisations, such as CCGs, to show that they are capable of carrying out their new functions safely and with appropriate governance. So there needs to be an authorisation process which looks at these new organisations and says whether they can carry out their functions or not.

And it is clear from the July document that NCB authorisation will be ongoing.

Broader development'We do not see authorisation as a one-off assessment, but rather as part of a broader developmental relationship between CCGs and the NCB', the document states.

So it will be the NCB that decides whether your CCG can be authorised.

August saw the publication of draft proposals in Developing clinical commissioning groups - Towards authorisation that shed further light on the NCB's role.

What this boils down to is that one part of the new NHS - the NCB - will be deciding whether another part of the new NHS - the CCG - is good enough to carry out its new role.

The odd thing is that if the NCB were to decide that, for example, all of the GPs in east London were not up to becoming authorised groups, then the organisation that would carry out their commissioning function would be - yes, you've got it - the NCB.

So the more CCGs that the NCB authorises, the less direct local commissioning the NCB will do. The incentive structure here is a little confusing. Is the NCB being incentivised to be very tough in its authorisation process and to only let a very few CCGs through? This certainly looks like it.

If I were part of a CCG that the NCB turned down in spring 2013, I might think it had been influenced by the fact that it will have the very power to commission that it has decided I am not to have.

Paul Corrigan is a management consultant and former special adviser to Tony Blair. More at www.pauldcorrigan.com

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